Antidepressant use and psychosis hospitalization in persons with schizophrenia

Introduction Antidepressants are often used by persons with schizophrenia. These medications are used for a variety of symptoms, such as negative or depressive ones. Effectiveness of antidepressant use in persons with schizophrenia has rarely been studied in the real-world setting. Objectives The aim of this study was to investigate the risk of hospitalization due to psychosis related to antidepressant use in persons with schizophrenia. Methods This cohort study utilized data combined from Finnish nationwide registers. The study cohort included all 61 889 persons treated in inpatient care due to schizophrenia (defined as International Classification of Diseases, ICD, version 10 codes F20-F25 during 1972–2014 in Finland). National Prescription register data was utilized to obtain drug purchase data, and modelled into drug use periods with PRE2DUP (From Prescriptions to Drug Use Periods) method, developed by our research group. The follow-up covered the years from 1996 to 2017. Antidepressants (Anatomic Therapeutic Chemical classification system, ATC code N06A) were categorized by mechanism of action (non-selective monoamine reuptake inhibitors, TCAs, ATC-codes N06AA, selective serotonin reuptake inhibitors, SSRIs, N06AB and serotonin-norepinephrine reuptake inhibitors, SNRIs, including venlafaxine, milnacipran and duloxetine), and also on drug-substance level. Main outcome was hospitalization due to psychosis (ICD-10 diagnoses F20-F29) as the main diagnosis. We used within-individual design to compare the risk of outcome between the time periods of antidepressant use and non-use within the same person to minimize selection bias. Stratified Cox regression analyses were utilized to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CIs). These analyses were then adjusted for sequential order of treatments, time since cohort entry, use of antipsychotics, mood stabilizers, benzodiazepines, and Z-drugs. Results The mean age of the study cohort was 46.2 (SD 16.0) years at cohort entry, and 50.3% of were males. Altogether 49.3% (N=30 508) of the study cohort used antidepressants during the follow-up (median 14.8 years, IQR 7.5-22.0), with citalopram and mirtazapine being the most commonly used antidepressants. The risk of psychosis hospitalization was lower during antidepressant use as compared to non-use (aHR 0.93, 95% CI 0.92-0.95). Use of SSRIs was associated with similar risk (aHR 0.91, 95% CI 0.89-0.93), followed by SNRIs (aHR 0.92, 95% CI 0.88-0.97) and TCAs (aHR 0.93, 95% CI 0.89-0.98). Considering individual drug substances, lowest risk were obserwed with use of sertraline (aHR 0.87, 95% CI 0.83-0.91), fluoxetine (aHR 0.88, 95% CI 0.83-0.91) and citalopram (aHR 0.92, 95% CI 0.90-0.95). Conclusions Use of antidepressants was associated with a 7% lowered risk of hospitalization due to psychosis, and AD subgroups did not differ in their real-world effectiveness. Disclosure of Interest A. Puranen: None Declared, M. Koponen: None Declared, M. Lähteenvuo Shareolder of: Genomi Solutions ltd, Nursie Health ltd, Springflux ltd, Grant / Research support from: Finnish Medical Foundation, Emila Aaltonen Foundation, Speakers bureau of: Sunovion, Lundbeck, Otsuka Pharma, Orion Pharma, Recordati, Janssen, Janssen-Cilag, A. Tanskanen Grant / Research support from: Janssen-Cilag, Eli Lilly, , J. Tiihonen Grant / Research support from: Janssen-Cilag, Eli Lilly, Consultant of: HLS Therapeutics, Orion, and WebMed Global, Speakers bureau of: Eli Lilly, Evidera, Janssen-Cilag, Lundbeck, Mediuutiset, Otsuka, Sidera, and Sunovion, H. Taipale Grant / Research support from: Janssen-Cilag, Eli Lilly, Academy of Finland, Speakers bureau of: Janssen-Cilag, Otsuka

Introduction: Antidepressants are often used by persons with schizophrenia.These medications are used for a variety of symptoms, such as negative or depressive ones.Effectiveness of antidepressant use in persons with schizophrenia has rarely been studied in the real-world setting.Objectives: The aim of this study was to investigate the risk of hospitalization due to psychosis related to antidepressant use in persons with schizophrenia.Methods: This cohort study utilized data combined from Finnish nationwide registers.The study cohort included all 61 889 persons treated in inpatient care due to schizophrenia (defined as International Classification of Diseases, ICD, version 10 codes F20-F25 during 1972F20-F25 during -2014 in Finland) in Finland).National Prescription register data was utilized to obtain drug purchase data, and modelled into drug use periods with PRE2DUP (From Prescriptions to Drug Use Periods) method, developed by our research group.The followup covered the years from 1996 to 2017.Antidepressants (Anatomic Therapeutic Chemical classification system, ATC code N06A) were categorized by mechanism of action (non-selective monoamine reuptake inhibitors, TCAs, ATC-codes N06AA, selective serotonin reuptake inhibitors, SSRIs, N06AB and serotoninnorepinephrine reuptake inhibitors, SNRIs, including venlafaxine, milnacipran and duloxetine), and also on drug-substance level.Main outcome was hospitalization due to psychosis (ICD-10 diagnoses F20-F29) as the main diagnosis.We used within-individual design to compare the risk of outcome between the time periods of antidepressant use and non-use within the same person to minimize selection bias.Stratified Cox regression analyses were utilized to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CIs).These analyses were then adjusted for sequential order of treatments, time since cohort entry, use of antipsychotics, mood stabilizers, benzodiazepines, and Z-drugs.Results: The mean age of the study cohort was 46.2 (SD 16.0) years at cohort entry, and 50.3% of were males.Altogether 49.3% (N=30 508) of the study cohort used antidepressants during the follow-up (median 14.8 years, IQR 7.5-22.0),with citalopram and mirtazapine being the most commonly used antidepressants.The risk of psychosis hospitalization was lower during antidepressant use as compared to non-use (aHR 0.93, 95% CI 0.92-0.95).Use of SSRIs was associated with similar risk (aHR 0.91, 95% CI 0.89-0.93),followed by SNRIs (aHR 0.92, 95% CI 0.88-0.97)and TCAs (aHR 0.93, 95% CI 0.89-0.98).Considering individual drug substances, lowest risk were obserwed with use of sertraline (aHR 0.87, 95% CI 0.83-0.91),fluoxetine (aHR 0.88, 95% CI 0.83-0.91)and citalopram (aHR 0.92, 95% CI 0.90-0.95).
Introduction: Although the immune system is thought to contribute to the etiology of schizophrenia, the mechanism has not been clearly elucidated.Clarifying the relationship between them is important in terms of diagnosis, treatment, and prevention approaches.
Objectives: In this study, it is aimed to determine whether there is any difference in serum levels of neutrophil gelatinase-associated lipocalin (NGAL) and tumor necrosis factor-alpha (TNF-α) in the group of patients with schizophrenia and healthy volunteers, whether these values are changed by medical treatment, whether there is any relation between these values and the severity of the symptoms of patients with schizophrenia, and whether NGAL can be used as a biomarker in the diagnosis and the follow-up of the schizophrenia.Methods: A total of 64 patients who were hospitalized in the Psychiatry Clinic of Xxxxxx and diagnosed with schizophrenia and 55 healthy volunteers were included in the study.A sociodemographic information form was given to all participants and TNF-α and NGAL values were measured.Positive and Negative Symptoms Rating Scale (PANSS) were applied to the schizophrenia group on admission and follow-up.TNF-α and NGAL levels were re-measured in the 4th week after the start of antipsychotic treatment.
Results: As a result of the present study, it was found that NGAL levels decreased significantly after antipsychotic treatment of schizophrenia patients hospitalized with exacerbation (Figure 1).There was no significant correlation between NGAL and TNF-α levels among schizophrenia and the control group.

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Conclusions: In psychiatric diseases, especially schizophrenia, there may be differences in immune and inflammatory markers compared to the healthy population.After treatment, the NGAL levels of the patients at follow-up were reduced in comparison with the levels at their admission.It can be thought that NGAL may be related to psychopathology in schizophrenia and antipsychotic treatment.This is the first followup study for NGAL levels in schizophrenia.

Disclosure of
Interest: A. Gül Çakıl Grant / Research support from: This study funded by the Turkish Republic SBU Scientific Research Projects Coordinatorship.(Project no: 2020/013), H. Kaya: None Declared, A. Sakallı Nural: None Declared, I. Çakmak: None Declared, I. Okay: None Declared, E. Göka: None Declared EPP0259 Impact of cannabis use and cannabis cessation on inflammation in patients with psychosis